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International Orthopaedics

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Open Access 01-06-2017 | Review Article

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

Authors: Gopal Shankar Krishnakumar, Alice Roffi, Davide Reale, Elizaveta Kon, Giuseppe Filardo

Published in: International Orthopaedics | Issue 6/2017

Abstract

Purpose

This paper documents the existing evidence on bone morphogenetic proteins (BMPs) use for the treatment of bone fractures, non-union, and osteonecrosis, through a review of the clinical literature, underlying potential and limitations in terms of cost effectiveness and risk of complications.

Methods

A systematic review was performed on the PubMed database using the following string: (bone morphogenetic proteins OR BMPs) and (bone repair OR bone regeneration) including papers from 2000 to 2016. The search focused on clinical trials dealing with BMPs application to favor bone regeneration in bone fractures, non-union, and osteonecrosis, in English language, with level of evidence I, II, III, and IV. Relevant data (type of study, number of patients, BMPs delivery material, dose, site, follow-up, outcome, and adverse events) were extracted and analyzed.

Results

Forty-four articles met the inclusion criteria: 10 randomized controlled trials (RCTs), 7 comparative studies, 18 case series, and 9 case reports. rhBMP-2 was documented mainly for the treatment of fractures, and rhBMP-7 mainly for non-unions and osteonecrosis. Mixed results were found among RCTs and comparative papers: 11 reported positive results for BMPs augmentation, 3 obtained no significant effects, and 2 showed negative results. The only study comparing the two BMPs showed a better outcome with rhBMP-2 for non-union treatment.

Conclusion

Clinical evidence on BMPs use for the treatment of fractures, non-union, and osteonecrosis is still controversial, with the few available reports being mainly of low quality. While positive findings have been described in many studies, mixed results are still present in the literature in terms of efficacy and adverse events. The difficulties in drawing clear conclusions are also due to the studies heterogeneity, mainly in terms of different BMPs applied, with different concomitant treatments for each bone pathology. Therefore, further research with well-designed studies is needed in order to understand the real potential of this biological approach to favour bone healing.

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Title: Clinical application of bone morphogenetic proteins for bone healing: a systematic review
Authors: Gopal Shankar Krishnakumar
Alice Roffi
Davide Reale
Elizaveta Kon
Giuseppe Filardo
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3471-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

Abstract

Purpose

Methods

Results

Conclusion

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Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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